Smarter Medicines Better Outcomes NICON2018 @moicni #nicon18

Your speakers Cathy Harrison Deputy Chief Pharmacist Department of Health Professor Mike Scott Director Medicines Optimisation Innovation Centre (MOIC) Director of Pharmacy and Medicines Management Northern Health & Social Care Trust

Medicines use in Northern Ireland 1.8m people More than £550m per year More than 40m items Accounts for 12% of HSC spend 19.9 items per head Increase of 5% each year Higher number of prescription items per head than England and Scotland Higher costs per head than any other UK country

Sub-optimal outcomes from medicines 3-6% of hospital admissions due to adverse effects, rising up to 30% in the elderly 1 in 15 hospital admissions are medicine related with two thirds being preventable 1 in 20 GP prescriptions contains an error 30-50% non-adherence to prescribed medication 2.5 million doses are administered in the average acute hospital (215,000 errors) In the UK it is estimated that such errors cost £770M* Variance of practice * 2007 figure

Medicines Optimisation “a person centred approach to safe and effective medicines use to ensure the best possible outcomes from their medicines” Definition by NICE

Medicines Optimisation Quality Framework Developed in response to the need to gain better patient outcomes from medicines and ensure effective use of healthcare resources, uses the Medicines Optimisation Model.

The Model

Key goals for medicines optimisation Support better adherence with prescribed medicines Improve polypharmacy management Reduce harm for high risk patients and medicines Support safer transitions of care Increase averse drug event reporting Increase knowledge, capacity and skills in health literacy Optimise the use of medicines resource within the HSC

Closing the gap

Medicines Optimisation Innovation Centre Research Quality Improvement Knowledge transfer Innovation

The Innovation Pipeline Regional scale and spread Regional scale and spread Quality Improvement and Innovation projects MO Steering Group Innovation work stream

Integrated medicines management (IMM) Drug history at admission reduction of 4.2 errors per patient Length of stay reduced by 2 days Increased time to readmission (20 days) Kardex monitoring (inpatient) 5.5 interventions per patient Faster medication rounds > 25 minutes per day saved Faster discharge > 90 minutes quicker More accurate discharge < 1% error rate compared to 25% Reduced risk adjusted mortality rate

Improved medicine use There was a significant improvement in the Medication Appropriateness Index (MAI)* Control 13.16 9.97 Intervention 17.48 5.69 *Burnett ,Scott ,Fleming et al. Am J Health System Pharm. 66;854-9 2009 Admission Discharge

Risk Adjusted Mortality Index

MO: completing the picture Systematic testing and scaling Post discharge follow up (NHSCT) Mental Health pharmacist (BHSCT and SHSCT) Doctor light discharge (NHSCT and SHSCT) Practice based pharmacists (HSCB) Out of hours supply (HSCB) Benzodiazepine use (HSCB) Community pharmacy (PACT and MEAPP)

MO: completing the picture Systematic testing and scaling Medicines Optimisation in Older People (MOOP) Intermediate care (WHSCT) Care homes (NHSCT) Adherence Pharmacist (SEHSCT and NHSCT) Consultant Care of the Elderly Pharmacist Network

Case management project Queen’s University Belfast Wessex Academic Health Science network Eastern Academic Health Science network North West Coast Academic Health Science network Association of British Pharmaceutical Industries (ABPI)

Educating and training colleagues via knowledge transfer Top row – denmark, Norway, ireland, Sweden, UK, Netherlands Bottom row – Egypt, estonia, Jordan, New Zealand, Palestine, Poland and Spain

Tallaght Hospital Dublin Ireland (PACT) What is this showing? Suggest we remove?

European Innovation Partnership on Active and Healthy Ageing 2016 EU Reference site 4 stars Twinning with NW Coast, Catalonia & Oloumuc

European Connected Health Alliance The Global Connector in Healthcare Bringing people, organisations, needs and solutions together Medicines Optimisation inter-ecosystem group www.echalliance.com info@echalliance.com @ECHalliance What is the purpose of this slide / title / do we need it?

Pharmaceutical companies Currently scoping a project related to an outcomes based value model including Health Economics (SEHSCT, NHSCT, WHSCT, GP Federations, Clinical Information Officers ) Looking at physical health aspects related to mental health medications( WHSCT, BHSCT, SHSCT and NHSCT)

Non pharmaceutical companies HCAI Point of care testing Iskus Health Ltd Goldshield Ltd Cardinal Health Data Analytics Hibergene Accelerate Healthcare Analytics Ltd Analytics Engines Ltd

Enabling technology Safe therapeutic economic pharmaceutical selection (STEPSelect) Electronic pharmacist intervention clinical system (EPICS) Medicines reconciliation and analytics software (Writemed) Antimicrobial surveillance system (LAMPS)

Medicines optimisation: Small Business Research Initiative(SBRI) How can technology help people to take their medicines on time and as prescribed? HOME How can technology help improve medicines use for service users and service providers in domiciliary care? FAST How can technology help optimise the use of pharmacy staff in hospitals by matching skills to patient acuity in real time?

Current collaborative funding bids Dutch Private Foundation Implementation of antimicrobial stewardship in hospitals in Ghana Interreg Our Lady of Lourdes Hospital Drogheda Queens University Belfast Trinity College Dublin CoST In association with European Colleagues led by Catalonia Norwegian Research Council with Norwegian, English and Swedish colleagues Dutch Private Foundation - Implementation of microbial stewardship in hospitals in Ghana Interreg- with colleagues in Our Lady of Lourdes Hospital in Drogheda , Trinity College ,Dublin , The Queens University of Belfast CoST - with a number of European Colleagues led by Catalonia Norwegian Research Council- with Norwegian, English and Swedish colleagues

WHO Global Challenge: Medication without harm Polypharmacy Safer transitions of care High risk medication situations Aim: medication harm reduction of 50% by 2023

cathy. harrison@health-ni. gov. uk @cathyharrison00 moic@northerntrust cathy.harrison@health-ni.gov.uk @cathyharrison00 moic@northerntrust.hscni.net @moicni www.linkedin.com/company/moic/